SINGLE INSTITUTION VARIABILITY IN INTENSITY MODULATED RADIATION TARGET DELINEATION FOR CANINE NASAL NEOPLASIA.

Contouring variability is a significant barrier to the accurate delivery and reporting of radiation therapy. The aim of this descriptive study was to determine the variation in contouring radiation targets and organs at risk by participants within our institution. Further, we also aimed to determine if all individuals contoured the same normal tissues. Two canine nasal tumor datasets were selected and contoured by two ACVR-certified radiation oncologists and two radiation oncology residents from the same institution. Eight structures were consistently contoured including the right and left eye, the right and left lens, brain, the gross tumor volume (GTV), clinical target volume (CTV), and planning target volume (PTV). Spinal cord, hard and soft palate, and bulla were contoured on 50% of datasets. Variation in contouring occurred in both targets and normal tissues at risk and was particularly significant for the GTV, CTV, and PTV. The mean metric score and dice similarity coefficient were below the threshold criteria in 37.5-50% and 12.5-50% of structures, respectively, quantitatively indicating contouring variation. This study refutes our hypothesis that minimal variation in target and normal tissue delineation occurs. The variation in contouring may contribute to different tumor response and toxicity for any given patient. Our results also highlight the difficulty associated with replication of published radiation protocols or treatments, as even with replete contouring description the outcome of treatment is still fundamentally influenced by the individual contouring the patient.

Characterization of a 0.35T MR system for phantom image quality stability and in vivo assessment of motion quantification.

ViewRay is a novel MR-guided radiotherapy system capable of imaging in near real-time at four frames per second during treatment using 0.35T field strength. It allows for improved gating techniques and adaptive radiotherapy. Three cobalt-60 sources (~ 15,000 Curies) permit multiple-beam, intensity-modulated radiation therapy. The primary aim of this study is to assess the imaging stability, accuracy, and automatic segmentation algorithm capability to track motion in simulated and in vivo targets. Magnetic resonance imaging (MRI) characteristics of the system were assessed using the American College of Radiology (ACR)-recommended phantom and accreditation protocol. Images of the ACR phantom were acquired using a head coil following the ACR scanning instructions. ACR recommended T1- and T2-weighted sequences were evaluated. Nine measurements were performed over a period of seven months, on just over a monthly basis, to establish consistency. A silicon dielectric gel target was attached to the motor via a rod. 40 mm total amplitude was used with cycles of 3 to 9 s in length in a sinusoidal trajectory. Trajectories of six moving clinical targets in four canine patients were quantified and tracked. ACR phantom images were analyzed, and the results were compared with the ACR acceptance levels. Measured slice thickness accuracies were within the acceptance limits. In the 0.35 T system, the image intensity uniformity was also within the ACR acceptance limit. Over the range of cycle lengths, representing a wide range of breathing rates in patients imaged at four frames/s, excellent agreement was observed between the expected and measured target trajectories. In vivo canine targets, including the gross target volume (GTV), as well as other abdominal soft tissue structures, were visualized with inherent MR contrast, allowing for preliminary results of target tracking.

Assessment of respiration-induced displacement of canine abdominal organs in dorsal and ventral recumbency using multislice computed tomography.

Respiratory-induced organ displacement during image acquisition can produce motion artifacts and variation in spatial localization of an organ in diagnostic computed tomography (CT) examinations. The purpose of this prospective study was to quantify respiratory-induced abdominal organ displacement in dorsal and ventral recumbency using five normal dogs. All dogs underwent CT examinations using 64 multidetector row CT (64-MDCT). A "3-dimensional (3D) apneic CT exam" of the abdomen was acquired followed by a "4-dimensional (4D) ventilated CT exam." The liver, pancreas, both kidneys, both medial iliac lymph nodes, and urinary bladder were delineated on the 3D-apneic examination and the organ outlines were compared to the maximum alteration in organ position in the 4D-ventilated examination. Displacement was measured in dorsal-to-ventral (DV), right-to-left (RL), and cranial-to-caudal (CC) directions. Respiratory-induced displacement of canine abdominal organs was not predictable and showed large variability in the three directions evaluated. For most canine abdominal organs, dorsal recumbency provided overall the least amount of displacement among all directions evaluated except for liver and urinary bladder. For liver, a large variability was found for all directions and a statistically significant difference was found only in the RL direction with ventral recumbency exhibiting less displacement (P = 0.0099). For the urinary bladder, ventral recumbency also provided less displacement but this was statistically significant only in the RL direction (P < 0.0001). Findings from this study indicated that dorsal recumbency may be preferred for minimizing respiratory motion artifacts in whole abdomen studies, but ventral recumbency may be preferred for liver and urinary bladder studies when respiration cannot be controlled.

Comparison of air sac volume, lung volume, and lung densities determined by use of computed tomography in conscious and anesthetized Humboldt penguins (Spheniscus humboldti) positioned in ventral, dorsal, and right lateral recumbency.

OBJECTIVE: To determine the effects of recumbency on air sac volume, lung volume, and lung densities in CT images of healthy, conscious and anesthetized spontaneously breathing Humboldt penguins (Spheniscus humboldti). ANIMALS: 25 adult (13 male and 12 female) Humboldt penguins. PROCEDURES: CT images of conscious penguins in ventral recumbency and anesthetized penguins in dorsal, ventral, and right lateral recumbency were obtained. Air sac volume, lung volume, and lung densities in CT images were calculated. A paired samples t test was used to determine whether right and left lung densities differed among recumbencies. Repeated-measures ANOVA (controlled for sex and order of recumbencies during CT) was used to determine whether air sac or lung volumes differed among recumbencies. RESULTS: Recumbency had a significant effect on air sac volume but not lung volume. Air sac volume was largest in conscious penguins in ventral recumbency (mean ± SD, 347.2 ± 103.1 cm(3)) and lowest in anesthetized penguins in dorsal recumbency (median, 202.0 cm(3); 10th to 90th percentile, 129.2 to 280.3 cm(3)). Lung densities were highest in anesthetized penguins in dorsal recumbency (right lung median, 0.522 g/cm(3); left lung median, 0.511 g/cm(3)) and lowest in anesthetized penguins in ventral recumbency (right lung median, 0.488 g/cm(3); left lung median, 0.482 g/cm(3)). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that anesthetized Humboldt penguins had the lowest air sac volume and highest lung densities in dorsal recumbency. Therefore, this recumbency may not be recommended. Minimal changes in lung volume were detected among recumbencies or between conscious and anesthetized penguins.